Defining Myelodysplastic Syndrome


A panel of experts open a discussion on the expanding awareness of myelodysplastic syndromes (MDS).

Ryan Haumschild, PharmD, MS, MBA: Hello, and welcome to this AJMC® Peer Exchange program titled “Updates in the Management of Myelodysplastic Syndromes.” I’m Dr Ryan Haumschild, the director of pharmacy with Emory Healthcare and the Winship Cancer Institute [in Atlanta, Georgia]. Joining me for this discussion are my colleagues Dr Amer Zeidan, an associate professor of medicine at the Yale School of Medicine in New Haven, Connecticut; Dr Salman Fazal, the director of the cell transplantation program at the Allegheny Health Network [in Pittsburgh, Pennsylvania]; and Dr Jay Weaver, a pharmacy benefits consultant with Solid Benefits Guidance [in Gainesville, Georgia].

This panel discussion adds to the conversation from our previous AJMC® Peer Exchange, in which we discussed oral therapy considerations in the management of myelodysplastic syndrome [MDS]. Our panel of experts will describe the clinical burden of MDS, discuss treatment paradigms and standard-of-care therapies, and explore the unmet needs and future directions in the treatment of myelodysplastic syndromes. Thank you for joining us. Let’s begin.

As we describe the impact of myelodysplastic syndromes, it’s important to talk about the clinical burden of the disease and the syndromes. Many people might be unfamiliar with myelodysplastic syndromes, some of the treatments, or the impact on the patient. Dr Fazal, if we can start with you, what are myelodysplastic syndromes? How does MDS compare with other hematologic malignancies?

Salman Fazal, MD: I’m glad you compared this with other hematologic malignancies, because sometimes patients and even physicians confuse myelodysplastic syndromes with blood disorders. The 2001 SEER [Surveillance, Epidemiology, and End Results] database recognized myelodysplastic syndromes as cancers. As physicians in the hematology world, we [think of] myelodysplastic syndromes as leukemias that can cause bone marrow failure. We believe that bone marrow has a role to play in our body that produces red blood cells, white blood cells, and platelets. Patients with myelodysplastic syndromes present with symptoms related to anemia, including shortness of breath and fatigue related to infection when their white blood cell count is low. If they have a low platelet count, then they’ll have bleeding complications.

One other way we distinguish one of the major misconceptions about this disease is that it’s referred to as preleukemia. A lot of literature in the past has referred to myelodysplastic syndrome as preleukemia. In reality, only 30% of patients with myelodysplastic syndromes evolve into acute leukemia. Most patients with a myelodysplastic syndrome have complications related to bone marrow failure, infections, bleeding complications, symptoms, and problems related to cardiovascular morbidity.

Ryan Haumschild, PharmD, MS, MBA: It’s interesting when you talk about all those different disease states. It impacts the patient when you’re trying to manage patient counts, when they have to have blood transfusions, and when they aren’t sure whether it’s a leukemia. Those are good differentiations.

Transcript edited for clarity.

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